System of operative surgery, founded on the basis of anatomy, Vol. 2

Page 46

or me TREAIMLNI or run are AFTER OPERATION . been discharged, and the incision of the cornea healed, it must be done by the needle, as practised in couching. i'ulness of the membranes, the consequence of a preceding vim olent inflammation. ' 1. In the first example, while the inflammatory action is 52 to be subdued, all that will excite, is to be removed in the 0F IKFLAMMA'IIOX 01' THE EYE, AND OF THE TREATMENT AFTER OPERATION. first stage; every surgeon of good practice forcwarns us to notice well that change which takes place, when instead of the violent throbbing, the acute pain, and hot watery dis- THE eye is necessarily the most delicate structure, and exposed more than any similar part of our frame. The natural delicacy and transparency of its membranes are preserv~ ed in a manner truly admirable. The tears which wash its surface, we must have observed, are acrid and stimulating, I'MFK Nj- -‘viIM‘h-rxau'ag‘r. M- _, M. w ,, ' h-f r .~'.b-‘:.-.*,r«;-r~‘- {me-«w-qy .5;--....,- l4.15M INUfA and when they run over the cheek, inflame and excoriate the surface. But the delicate surface of the eye and eyelids are accommodated to the presence of this fluid, and the advantage resulting from this is, that the surface is not disordered or irritated by any lesser degree of stimulus, and consequently it bears the variations of the atmosphere, and the excitements it is necessarily exposed to. Yet when we consider the exposure of the surface of the charge, there is only a swelling and turgessenee in the membranes, with a diminished irritability, the eyelids more flac- cid, the fieriness being gone though the redness remain, and the pupil be more dilated; now the evacuations, the soothing and emollient applications, which were necessary at first, will only continue the symptoms, and tend to fix the como plaint, while cold stimulating and astringent applications, the eye: 1. An acute inflammation, with evident symptoms of constitutional derangement, marked by nausea and a fun red tongue, or accompanied with inflammation of the mucous membrane of the nose, and sinuses, and symptoms of in« flammatory fever; or an inflammation similar in symptoms, are to be employed. The mere consequences of violent ophthalmia, and which are not to be considered as fixed or peculiar diseases, are the filly/elem, which are small vescicles formed on the surface of the eye; the clzcmosis, which is the swelling and projection of the conjunctiva; the puriform discharge from the eyelids, (which when in a remarkable degree, I am inclined to believe is always owing to matter communicated to the eye); the Izg/popion, which is a deposition of coagulable lymph in the anterior chamber of the aqueous humour ; the bursting and total destruction of the eye ; all these, as sure consequences of the high inflammation, are to be prevented or cured by removing the inflammation. But the several diseases I have now to mention, as requiring operation, we may better consi~ der as the consequences of the continued chronic ophthalmia, and which from the slowness of their formation do gradually acquire a kind of constitutional permanency which requires but .most commonly resulting from outward impression. excision. f). A lower degree of inflammation, chronic, and resisting lo- cal remedies, which is resulting from some derangement of the system. 3. Lastly, an inflammation only resembling the I may say once for all, what I conceive to be necessary in the examination of these diseases, inorder to discover if any thing should be done previous to operation, and what treatment is eye, and the delicacy and yaseularity of its membranes, we cannot wonder that it should be often inflamed, and often sufl‘er from those derangements of the constitution which are not to be remarked but by some such local afi‘ection as chronic inflammation of the eye. _ I see chiefly these distinctions in the inflammation of others in appearance, the effect of local debility in the eye, to be pursued after the operations upon the eye, when i uflam- and characterized by a relaxed state of the vessels, and a mation is a consequence.